Tata-Dhan Academy

T. Malaipatti, Thenkarai BO, Mullipallam SO, Sholavandan (Via), Vadipatti Taluk
Madurai District 625 207. Tamil Nadu, India

Application Form

Fifteenth International Advanced Reflective education and Training (ART) Course on Micro Insurance (Risk Transfer Solution to Address Poverty)
January 22-25, 2018

Instructions

  • All fields are compulsory. 
  • Don't leave any box/column blank unless specified as optional.

Name:

Gender:

Nationality:

Marital Status:

Organisation:

Designation:

Address for Communication

Pincode:

Telephone No. with STD code:

Email:

Fax:

For International Participants only

Passport No:

Name as mentioned in the passport:

Date of Birth: - -

Passport Details(Validity, Place of Issue etc):

Address of Indian Embassy/Consulate for VISA

Telephone No. with STD code:

Fax:

Email:


Work Experience
Date Organisation Position Nature of Job
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What are your expectations from this programme?(Write in this box not exceeding 200 words.)

Kindly attach your organisation profile along with your application.


Proficiency in English: Read Write Speak (Please tick)


Date: ___________________

Signature: ________________________

 

Nomination by the organisation

 

We, hereby nominate Mr./Ms. ________________________________________ to participate in the Thirteenth International Advanced Reflective education and Training (ART) Course on Micro Insurance, being conducted by Tata-Dhan Academy, Madurai, Tamil Nadu, India from December 8 to 11, 2015.

 
 

Signature

Date: ___________________

Name: ____________________________